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Investigation and inquest
On 22nd November 2021 I commenced an investigation into the death of Stevyn CARR, 34 years old. The investigation concluded at the end of the inquest on 6th March 2024. The conclusion of the inquest was Drug & Alcohol Related.
The medical cause of death was;
1a Cardiac Arrhythmia
1b Chronic Excess Alcohol Consumption and Use Of Amphetamine
I found at inquest, Stevyn Carr died on 16th November 2021 at 17 Lytchfield, Leam Lane, Gateshead from a cardiac arrhythmia caused by the toxic effects of him voluntarily consuming a quality of alcohol and amphetamines at some point prior to his death. His intention in doing so was not to end his life.
Circumstances of the death
Stevyn Carr contacted Northumbria Police on the evening of 15th November 2021 at 7.22pm. His contact with police call handlers and emergency operators was difficult to understand, due to on balance to his intoxication. He did ask for ‘Help’ and he was told police would attend. The calls to police were assessed a Grade 2 response - normally within an hour. No police attended until they entered Stevyn Carr’s address at 12.02pm on 16th November after members of his family contacted the police at 10.38am to express their concerns for him. He was discovered dead when police entered his home.
On the evidence heard it was not possible to ascertain whether earlier police attendance would have altered the outcome.
From the first call to police to his discovery by police a period of 16 hours 40 minutes elapsed.
Coroner’s concerns
(1) The evidence I heard at inquest indicated the level of police response should have been classed as a Grade 2 Vulnerable to ensure a more timely response.
(2) No oversight of the incident took place for over 9 hours and at that a comment was made that there were no resources able to attend, but no other options/alternatives were pursued.
(3) The family of Stevyn Carr contacted police some 15 hours after the first call to the police and after this a further 1 hour and 23 minutes elapsed before police went to his address and found him.
(4) I heard evidence at inquest that a number of incidents were ‘delayed’ for a significant period for lack of police resources and this position was common place at that time.
(5) I have asked for evidence to satisfy me that the position in terms of police attendance has improved both within the area Stevyn Carr died, but across the Northumbria Police force area. The evidence I have received is difficult to interpret and not comprehensive. I am concerned whether the changes to the management of incidents and/or training in relation to the grading of incidents by Northumbria Police has improved since Stevyn Carr’s death, to the extent that the timeliness of police response to requests from the public for assistance is improved and is improving.
Information checked against the published report and official responses